Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver

An assessment that there is documentation in the medical record that a Home Management Plan of Care (HMPC) document was given to the pediatric asthma patient/caregiver

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Asthma is the most common chronic disease in children and a major cause of morbidity and health care costs nationally (Adams, et al, 2001). In 2005, 5.2% of children with asthma had at least one asthma attack in the previous year (3.8 million children). Nearly two of every three children who currently have asthma had at least one attack in the past 12 months. Chronic asthma in children can account for an annual loss of more than 14 million school days per year, according to the Asthma and Allergy Foundation (Asthma Facts and Figures).

It is clear from multiple sources of evidence including the National Heart Lung and Blood Institute (NHLBI) Guidelines that actual self-management of asthma by the patient or caregiver leads to more positive outcomes. Appropriate self-management is completely reliant upon patient education. Patient education is more effective when it aims at training self-management skills that will alter behavior (Norris, et al, 2001).

NHLBI notes that review of asthma management by expert clinicians is necessary but not sufficient to improve outcomes. Active learning, participating and verbalization of understanding are all strategies that a healthcare organization must incorporate with parents or caregivers of asthmatic children in order for them to understand and make the appropriate changes that can impact the disease in the child in question. Education programs have been effective in improving lung function, feelings of self-esteem, and consequently decreased missed days of school in children and adolescents (Phipatanakul, 2004). Acute hospitalization follow up is imperative to a successful discharge from the hospital, providing the caretaker with the resource information needed to contact the follow up facility, medical office or clinic setting (Schatz, et al, 2009).

Environmental control consists of removal of asthma triggers from the environment. Multiple studies support the positive correlation of household maintenance factors such as control of cockroach dust, and the number of acute asthma attacks in asthmatic children (McConnell, et al, 2005 and Eggleston, et al, 2005). Evidence from Carter et al, (2001) supported by the National Institute of Health (NIH) grant found specifically that reduction in triggers such as household conditions i.e. dust mites, cockroach, cats and presence of molds and fungus, resulted in a decrease in acute care visits and an overall positive outcome of children.

Rescue action education related to early recognition of symptoms and proper action to control incidence of asthma attacks is noted to have positive outcomes for asthmatic children (Ducharme and Bhogal, 2008).

Under-treatment and/or inappropriate treatment of asthma are recognized as major contributors to asthma morbidity and mortality. National guidelines for the diagnosis and management of asthma in children, recommend establishing a plan for maintaining control of asthma and for establishing plans for managing exacerbation.

Improvement noted as an increase in rate

Adams RJ, Fuhlbrigge A, Finkelstein JA, Lozano P, Livingston JM, Weiss KB, and Weiss ST (2001). Use of Inhaled Anti-inflammatory Medication in Children with Asthma in Managed Care Settings. Archives of Pediatrics and Adolescent Medicine, 155, 501-507.

Asthma Facts and Figures. Retrieved on February 27, 2018 from http://www.aafa.org/page/asthma-facts.aspx.

Ducharme FM, Bhogal SK. The role of written action plans in childhood asthma.  Curr Opin Allergy Clin Immunol. 2008 Apr;8(2):177-88.

Eggleston, P.A., Butz, A., Rand, C., Curtin-Brosnan, J, Kanchanaraksa, S, Swartz, L, Breysse, P, Buckley, T., Diette, G., Merriman, B., Krishnan, J. (2005). Home Environmental Intervention in Inner-City Asthma: A Randomized Controlled Clinical Trial. Ann Allergy Asthma Immunology; 95 p518-524

McConnell, R., Milam, J., Richardson, J., Galvan, J., Jones, C., Thorne, P.S., and Berhane, K. (2005). Educational Intervention to Control Cockroach allergen Exposure in The homes of Hispanic Children in Los Angeles; Results of the La Casa Study. Clinical Exp Allergy; 35, p426-433

National Asthma Education and Prevention Program, http://www.nhlbi.nih.gov/about/org/naepp.

National Heart Lung and Blood Institute (NHLBI). Guidelines for the Diagnosis and Management of Asthma (EPR-3). Retrieved on February 17, 2015 from:  http://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines.

Phipatanakul, W. (2004). Effects of Educational Interventions for Self-Management of Asthma in Children and Adolsecents:Systematic Review and Meta-Analysis. Pediatrics; 114; 530. 

Schatz, M, Rachelefsky, G, Krishnan, J.A. (2009). Follow-up after Acute Asthma Episodes. What Improves Future Outcomes. Proc Am Thorac Soc; Vol 6 p 386-393.

Zemek, R.L., Bhogal, S.K., Ducharme, F. M. (2008). Systematic Review of Randomized Controlled Trials Examining Written Action Plans in Children: What is the Plan? (Reprinted) Arch Pediatr Adolesc Med/ vol 162 No 2. Retrieved on February 17, 2015 from http://archpedi.jamanetwork.com/article.aspx?articleid=379087.

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The home management plan of care document should be a separate and patient-specific written instruction. The document must be present in the form of an explicit and separate document specific to the patient rather than components or segments of the plan spread across discharge instruction sheets, discharge orders, education sheets, or other instruction sheets.

The home management plan of care is represented in the eMeasure logic by a LOINC code for an asthma action plan document. This form, or equivalent, contains most of the components required for the home management plan of care, including information on:
*	Methods and timing of rescue actions: the home management plan of care addresses what to do if asthma symptoms worsen after discharge, including all of the following: 1) When to take action, i.e., assessment of severity (eg, peak flow meter reading, signs and symptoms to watch for); 2) What specific steps to take, i.e., initial treatment instructions (eg, inhaled relievers up to three treatments of 2-4 puffs by MDI at 20-minute intervals or single nebulizer treatment); 3) Contact information to be used, when an asthma attack occurs or is about to occur.
*	Appropriate use of long-term asthma medications (controllers), including the medication name, dose, frequency, and method of administration.
*	Appropriate use of rescue, quick-relief, or short acting medications of choice to quickly relieve asthma exacerbations (relievers), including the medication name, dose, frequency, and method of administration.
*	Environmental control and control of other triggers: information on avoidance or mitigation of environmental and other triggers.

In addition to the information outlined in the asthma action plan form (or equivalent document), the home management plan of care is required to include information regarding arrangements for referral or follow-up care with a healthcare provider, namely:
*	If an appointment for referral or follow-up care with a healthcare provider has been made, the home management plan of care is required to include the provider/clinic/office name, as well as the date and time of the appointment.
*	If an appointment for referral of follow-up care with a healthcare provider has NOT been made, the home management plan of care is required to include information for the patient/caregiver to be able to make arrangements for follow-up care, i.e., provider/clinic/office name, telephone number and time frame for appointment for follow-up care (eg, 7-10 days).

The home management plan of care can only be considered to comply with the criteria outlined in the measure logic if it meets the requirements outlined above and is appropriately filled-out with information specific to the patient.

Patient refusal includes refusal by a caregiver. The caregiver is defined as the patient's family or any other person (eg, home health, VNA provider, prison official or other law enforcement personnel) who will be responsible for care of the patient after discharge.

The "Discharge To Home Or Police Custody" value set also intends to capture the following discharge disposition values:
* Assisted Living Facilities
* Court/Law Enforcement - includes detention facilities, jails, and prison
* Home - includes board and care, foster or residential care, group or personal care homes, and homeless shelters
* Home with Home Health Services
* Outpatient Services including outpatient procedures at another hospital, Outpatient Chemical Dependency Programs and Partial Hospitalization.

TBD

Pediatric asthma inpatients with an age of 2 through 17 years, and length of stay less than or equal to 120 days that ends during the measurement period

Patients discharged to home or police custody

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Pediatric asthma inpatients with:
A.  Documentation that they or their caregivers were given a written Home Management Plan of Care (HMPC) document that addresses all of the following: 
1. Arrangements for follow-up care 
2. Environmental control and control of other triggers
3. Method and timing of rescue actions
4. Use of controllers 
5. Use of relievers
 
-OR-
 
B.  Pediatric asthma inpatients with documentation that they or their caregivers refused a written Home Management Plan of Care (HMPC) document. Patient refusal includes refusal by a caregiver. The caregiver is defined as the patient's family or any other person (e.g., home health, VNA provider, prison official or other law enforcement personnel) who will be responsible for care of the patient after discharge.

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

eMeasure Children's Asthma Care (eCAC)